vulnerable and ashamed, bi er and grateful, inadequate and excited. In therapy a lot of work is put into this. Notice what you feel, notice where you feel it in your body, and label it. It is common for people to recognize the physical sensations, but have no idea what that emotion is; perhaps a legacy of past teachings that we don’t talk about emotions. Nobody needed a name for each di erent emotion because they never voiced it out loud. But they were able to pick out the physical manifestation of it because it has always been more acceptable to tell someone you feel sick and have a pounding heart, than to say you feel vulnerable and insecure. Increasing your emotional vocabulary so that you can distinguish finely between di erent emotions helps you to regulate those emotions and choose the most helpful responses in social situations (Kashdan et al., 2015). Self-soothing When painful emotions become intense, it’s very easy to say they will rise, peak and descend, but the reality of that experience can be excruciating, and lead to strong urges to do unhealthy or even dangerous things to make it all disappear sooner. While some self-help books might tell you that you can just think positive thoughts to change how you feel, I would say that’s going to be a struggle. Trying to change how you think is hard enough when you are feeling fine. Trying to change the thoughts that arrive at the height of distress feels nearly impossible. When we are overwhelmed, the best strategy is to step back and be mindful of that emotion as much as possible, see it as a temporary experience, and to turn down the dial on our threat response by soothing our way through it. In a therapy called Dialectical Behaviour Therapy (DBT) we teach individuals how to soothe their way through distressing emotions with simple skills that help you to ride the wave until it comes back down.
These are called distress tolerance skills. One of those skills is called self-soothing (Linehan, 1993). Self-soothing is any set of behaviours that help you to feel safe and soothed as you experience a painful emotion. When your threat response is triggered, the message being received by your brain is, ‘We are not safe! All is not OK! Do something about this now!’ If we want that distressing emotion to stop escalating and start its process of coming back down to baseline, we need to feed our body and brain new information that we are safe. There are lots of ways we can do this, because your brain takes its information from each of your senses. That means you can use each of those to send messages to your brain that you are safe. Your brain also takes its information from the physical state of your body, including your heart rate, breathing rate and muscle tension. This is why physical experiences that relax muscles, such as a warm bath, can be e ective in contributing to ge ing you through distress. Other self-soothing ideas include: A warm drink A chat with a trusted friend or loved one Physical movement Calming music Beautiful images Slow breathing Relaxation techniques A scent or perfume you associate with safeness and comfort One of the quickest ways to tell your brain that you are safe is actually through your sense of smell. Finding a scent that you associate with safety or comfort, maybe the perfume of a loved one or a lavender scent that you find calming, can be helpful in helping you to focus the mind and calm the body at the same time. For those who struggle with distressing emotions when out in public, here’s an example. A popular
choice in therapy has been to carefully unstitch a so toy, fill it with lavender, and sew it back up. Then whenever you are out in public and start to feel overwhelmed, you can breathe in the scent and ground yourself, soothe yourself through it without anyone even noticing. A great tool that is o en used in DBT is to create self-soothing boxes. The reason this is such a great idea is that when you are in emotional pain, at the height of your distress, your brain is set up to bypass your problem-solving capabilities. If you are under threat, you don’t have time to think things through. This is when your brain makes a quick guess for you and acts on impulse. A self-soothing box is something you prepare in advance, when you are able to think through what most helps in times of distress. Grab an old shoe box and fill it with anything that could help to soothe you when you are in distress. As described above, anything that you associate with feelings of safety and comfort is great to include. I have a self-soothing box in my therapy room that I use as an example. Inside that box is a note to call a particular friend. Seeking help may not be our first thought when we are struggling, but following a simple instruction to call a trusted friend can steer us in the right direction. As we know from previous chapters, human connection helps us to recover from stress more quickly. Other things that I included in my self-soothing box are a pen and pad of paper. If you cannot bring yourself to talk, then expressive writing has been shown to help us to process emotion and make sense of what is happening. The box could also include lavender oil (or any scent that you associate with comfort), some photographs of people who care about you and whom you care about, and a list of soothing or upli ing music tracks to play. Carefully chosen music can have a powerful impact on our emotional state. Create a playlist of tracks that will help you to feel calm, safe and soothed when you are distressed. My box also includes a teabag, because in England we associate tea with comfort and connection. Including something like this in the box is
simply a clear instruction to follow when you might otherwise be struggling to think through what you need. Crucially, keep that box somewhere that is easy to find when you might need it. This tool is all about making things easier for you to cope in the way that you want to during the toughest of times, to help you stay away from the less than healthy habits when you are vulnerable to using them.
Chapter summary You are not your feelings and your feelings are not who you are. The sensation of emotion is an experience that moves through you. Each emotion can o er you information but not necessarily the whole story. If there is something emotions are useful for, it’s telling us what we need. When you feel something, give it a name. Try to label emotions with more detail than just happy or sad. Allow emotions to be present and soothe your way through, rather than blocking them out.
CHAPTER 12 How to harness the power of your words The language we use can have powerful e ects on our experience of the world. It is our tool for making sense of things, helping us to categorize sensations, learn from past experiences, share that knowledge and predict and plan for future experiences. Some words for emotions have gradually been used more and more to mean di erent things, until they have taken on broad and vague meanings. ‘Happy’ has become an umbrella term for anything positive, to the extent that nobody really knows if what they are feeling qualifies as ‘happy’. If I feel passionate, am I happy? If I feel calm and content, am I happy? If I feel inspired and energized, is that happy? The same has happened to words like depression. What is a depressed mood, exactly? Sadness? Emptiness? Agitation? Numbness? Uneasiness? Restlessness? Flatness? And does any of this really ma er? Well, as it turns out, it does. Having fewer concepts or words to di erentiate discrete negative emotions is associated with higher levels of depression a er stressful life events (Starr et al., 2020). Those who are able to distinguish between negative feelings tend to be more flexible in how they respond to problems. For example, they are less likely to binge drink under stress, are less reactive to rejection and show less anxiety and fewer depressive disorders (Kashdan et al., 2015). This does not mean that those things are caused by the di culties in distinguishing
between negative feelings, but it does show that we have a powerful tool that we can use to help us through di cult times. The more new words you can build up to di erentiate between feelings, the more options your brain has for making sense of various sensations and emotions. When you have a more accurate word for a feeling, this helps to regulate your emotions and in turn means less stress for your body and mind overall. This is a crucial tool if you want to be more flexible and e ective in how you respond to challenges that you face (Feldman Barre , 2017). The good news is that this is a skill we can all keep building upon. Here are some ideas for how to build up your emotional vocabulary. Get specific. When you feel something, try to go beyond ‘I feel awesome,’ or ‘I’m not happy.’ What other words can you use to describe this feeling? Is it a combination of feelings? What physical sensations do you notice? One emotion label may not be enough to encapsulate this feeling. Is it a combination of feelings? For example, ‘I feel nervous and also excited.’ There is no right or wrong way to label an emotion. The key is to find a description that you and the people around you can become familiar with. If you can’t find the words, you can make up your own or find words from other languages that don’t have a clear translation. Explore new experiences and play around with ways to describe those experiences. From tasting new foods, to meeting new people, reading books or visiting somewhere new. Each new experience o ers the opportunity to view things from a di erent perspective. When it comes to building up the ability to describe those new experiences, take every opportunity to learn new words. This does not have to only come from books (although it can). It can also
come from music, movies and any other place that exposes you to new words to describe how you feel. Write down experiences and explore ways to describe how you felt. If you o en feel at a loss for words when trying to describe how you feel, and need help to build up your emotional vocabulary, the Feeling Wheel (Willcox, 1982) is a great resource that is o en used in therapy for exactly this purpose. You can keep a copy in the cover of your journal and use it to find more specific words. You can also use the blank spaces to add in your own words as you come across them in other places. Figure 7: Use the Feeling Wheel (Wilcox, 1982) to help you find the words to describe how you feel. Don’t only focus on the negative emotions
Journalling is a helpful way to process and understand the experiences and emotions that happen to you. But journalling is not only helpful for making sense of di cult experiences. It’s also important to spend time writing about positive experiences, even small moments that felt positive. This is because every action is a specific pa ern of neural activity in the brain. When you repeat an activity over and over, that neural pathway is strengthened and becomes easier for your brain to access. So if you want to be able to more easily cultivate positive feelings, thoughts and memories, put in the practice by keeping a journal. When you get practise at cultivating certain feelings and experiences in this way, it gets easier to access those feelings in the future.
Chapter summary The language we use has a powerful e ect on our experience of the world. The more words you have to describe how you feel, the be er. If you don’t have the words you can use something like the Feeling Wheel to give you prompts. Notice the words others use, read books and explore the ways you can keep building your emotional vocabulary.
CHAPTER 13 How to support someone If you are supporting a loved one as they struggle with their mental health, it is quite possible that you feel completely inadequate. You don’t know how to fix it, you’re not sure what is the right thing to say. You want to make it all OK for them. But you can’t. So you feel lost, desperately wanting to help and not knowing how. When someone we love is su ering, sometimes the stress that it brings up can give us the urge to escape how we feel about their pain. But when we do that, we can feel even more helpless and paralyzed because we stop ourselves from providing even some low-level support that could help us to feel more confident in the supporting role (Inagaki et al., 2012). While there are no hard and fast rules for supporting someone through mental health problems, there are a few things that can help along the way. 1. When we focus on trying to fix the problem, it is easy to underestimate the power of simply being there. Most people don’t want to be told what to do. But they do want someone to keep showing up to check in and show they care. 2. If the loved one has a specific diagnosis, it can help to learn about how it a ects them and get more specific advice on the challenges they are facing. 3. Don’t forget that the person you are supporting will have an idea of what they need. So asking them how they would like you to
support them can help to give you guidance, while also communicating to them that you are listening. 4. Caring for someone can put a strain on your own mental health. But you cannot support them at your best if your mental health starts to deteriorate. So it is absolutely imperative that you prioritize your own health too – even in small ways. Keep a close eye on the basics. Keep track of your sleep, routine, nutritional intake, exercise and social contact. 5. Get your own support. Whether it be someone you trust, a support group or a professional, having a safe space to talk about your own feelings and think about how to move forward can help to stop you burning out. 6. Set boundaries. Supporting someone else does not mean that your life no longer ma ers. Ge ing clarity on your own values can help to keep you going when things get tough, but also to ensure that you can maintain some balance. 7. Work on a crisis plan. If the person you are caring for ever feels unsafe, then it is important to have a crisis plan. It doesn’t need to be complex. Acknowledge any early warning signs that things may be deteriorating and list the things that both of you can do to ensure everybody’s safety in that scenario. Having a wri en plan with all the numbers you need to call makes it easier to do what you need to in a crisis. 8. It is easy to underestimate the power of listening with compassion, kindness and curiosity. The problems may not disappear when you do that, but you are helping that person to feel cared for and less alone, which greatly improves their chances of recovery. Social support is a powerful tool and it does not need to come with all the answers, just a big dose of compassion. 9. Supporting someone does not mean that you have to connect with big, intense conversations. Human connection in the smallest of moments ma ers. Walking while you are talking can help those who feel uncomfortable with opening up. You can also say nothing
at all. Simply spending time together, even in silence, is OK. By being there, you are helping them to feel less alone and more cared for. 10. If you are trying to help that person open up about their struggles, using open questions that ask for more than a yes or no answer can help. For example, rather than ‘Are you OK?’ try ‘What are you thinking?’ 11. Listen carefully. Don’t o er advice unless they ask for it. Just reflect back what you hear them saying; let them know they are being heard and respected. 12. If that person talks about feeling hopeless or helpless, says that they cannot see a way out, or you become concerned about their safety, always seek professional advice. 13. Don’t underestimate the power of practical help. If someone is facing struggles with mental health, physical health, pre- and postnatal periods, or grief, all of these can make the usual day-to-day tasks more di cult. For example, helping someone to eat a few healthy meals each week by turning up with a home-made dinner is a great way to support a loved one. 14. Being sensitive to situations in which your loved one may feel especially vulnerable (or asking them if you don’t know) means that you can be there for them when they most need it. For example, if a loved one is recently bereaved and has to a end a social function alone for the first time, don’t avoid them. Lean in and show them love and kindness. Those situations will still be hard, but feeling less alone can mean everything. 15. It’s OK to change the subject. Being around someone does not mean you have to focus on their struggles the whole time. Distraction can be a welcome relief that they might find di cult to achieve when alone. 16. Have no expectations about their healing or recovery. It is never smooth and linear. There will be good days and bad days. Being
surrounded by loved ones who are accepting of those ups and downs over the years will help them to do the same. 17. Be honest. If you want to be supportive but you are not sure how, say that out loud. Ask the person to let you know if you are saying or doing something that is not helpful. This openness allows everyone to feel less anxious and to truly connect, knowing that the situation is working for everyone.
Chapter summary It is normal to feel overwhelmed or inadequate when supporting someone with mental health problems. You want to fix it but you don’t know how. Leaning in to support someone who is su ering can be stressful as you don’t want to say the wrong thing. But don’t avoid them. You don’t have to fix everything to be a great support. Look a er yourself to prevent burnout. Get your own support and set clear boundaries. Never underestimate the power of listening.
CHAPTER 14 Understanding grief We o en associate grief with the death of a loved one. But we can grieve at other times too. Endings that feel significant to us can trigger a grief reaction – even if the ending was not caused by death. We have fought our way through a pandemic that changed our lives. Along the way we lost friends, family, livelihoods, jobs, family businesses built over generations. We lost financial security, final moments with loved ones, and precious time to hold and be close to them. We lost a sense of certainty about what the future holds, and access to the social support that would help us cope with that. The profound losses experienced by so many have changed the world and le a psychological fallout that is heavy with grief. For anyone feeling the e ects of a loss, these are some things to remember. Grief is normal I have met so many people who tell themselves that they are failing at life because they are struggling to cope with grief. They make broad judgements about their strength of character, as if grief is a disorder or a problem they should have fixed. Grief is a normal part of human experience. It is a necessary process to go through when we experience the loss of someone or something that we loved, needed, felt connected to and that held meaning in our life.
Sadness can be a part of grief. But there is much more to grief than sadness. It can be a deep yearning for the person who is gone. Relationships are at the core of what it means to be human. Among the people I have met in my career so far, their human connections have been the most meaningful aspects of their lives. When the relationship ends, the need for that connection doesn’t stop. Your body grieves too. As explained in previous chapters, everything we think and feel happens within the body. Grief is no di erent. The loss of a loved one is a huge psychological and physical threat. The pain can feel both emotional and physical. The stress response is repeatedly triggered. In talking about things that help us through grief, let’s be clear on what help means. Things that help do not make the pain disappear or make us forget or force us to let go. Help might be as simple as finding out that the rollercoaster of emotions you feel is normal. It might be finding new ways to sit with and process the pain in a safe and healthy way. Grief can feel intolerable. It makes absolute sense that our most natural human response to that might be to block it out. The pain is so intense and vast that it is terrifying. So we push it away if we can. But when we block one emotion, we tend to block them all. We can be le feeling hollow, numb and struggling to find meaning and to engage with life in the way we once did. If we find a way to push it all down under the surface, maybe by keeping really busy, numbing ourselves with alcohol or with denial of what has happened, we may feel like we’re doing OK. Then something small that seems insignificant blows the lid o and this world of pain explodes, leaving us in shock and questioning whether we can cope. Unresolved grief is associated with depression, suicidality and alcohol abuse (Zisook & Lyons, 1990). So denying our grief and pushing it away feels like self-protection but in the longer term can be the opposite. How easy it is to say all this. How hard it is in reality to experience it. When we block out pain, it is for good reason. An ocean of grief as
deep as it is wide, it feels too big, too much, never-ending. How do we possibly face something like that? We can start by understanding what to expect. We can also make sure we get to know what helps us navigate the experience. Then we take things one experience at a time. We take a few strides into that ocean of grief. We feel it. We breathe. We step back and rest for a moment. Over time we learn to take more steps, go deeper, immerse ourselves, knowing that we can safely return to the shore. Feeling the grief does not make it disappear. But we build up our strength to know that we can be reminded and yet still return to engage with life as it is today.
Chapter summary Endings that feel significant can trigger a grief reaction – even if the end was not caused by death. Grief is a normal and natural part of being human. The pain can feel both emotional and physical. Things that help do not make the pain disappear or force you to let go. Trying to completely block out grief can lead to problems further down the line.
CHAPTER 15 The stages of grief You might have heard about the stages of grief as originally described by Elisabeth Kubler-Ross (1969). Since then, it has been established that they are not experienced in stages and they do not happen in any particular order or time-frame. But they do describe some of the most common experiences that can be a part of normal, healthy grief. It is important to remember that these are not a prescription for how you should be grieving. They are not a rule book for the best type of grieving. They are descriptions of experiences you might notice along the way. So if you recognize any of them in your own experience, or in a loved one, you know these are a part of normal, healthy grief. Denial Denial and shock can help us survive the overwhelming pain of grief. It does not mean that we deny any of it is happening. But there may be a gradual pacing of how you take on board the situation you are facing and the new reality that awaits you, whether you chose it or not. Over time, denial begins to fade and this allows new waves of emotion to surface. Anger Underneath anger is o en intense pain or fear. When we allow ourselves to truly feel that anger and express it, we can bring those other emotions to the surface and work on them. But many people have been taught to fear anger and to feel ashamed of expressing it.
So we hold it under the surface, but like holding air under water, it soon bubbles up in another time or place. An outburst at a friend or doctor or family member that appears out of character. Anger is there to agitate us to move and make something happen. When we experience anger about something that we cannot control, using physical movement helps us to use that physiological arousal in the way it was designed to be used. Venting in that way can be helpful to use up that energy generated by anger and bring ourselves back down to baseline, at least for a while. Once the body is calm, you are then more able to access the cognitive function necessary to get clarity on your thoughts and feelings or any problem-solving to be done. It can be helpful to do that with a trusted friend or loved one who can support you, or by writing things down. We know from the research that ruminating alone on angry feelings can make the anger and aggression more intense rather than less (Bushman, 2002). Trying to do any sort of deep relaxation exercise before you have used physical action to move through the anger and bring your level of arousal back down may be too di cult. But once you have expressed it in any way that best suits you, using guided relaxations can be helpful to replenish the body and mind until the next wave of anger arrives. Bargaining Maybe this occurs in fleeting moments. Maybe it’s hours or days spent ruminating over the ‘What if …’ and ‘If only …’ thoughts. This can easily lead down a path towards self-blame. We start to wonder what could have been di erent if we had made di erent choices at di erent times. We may start bargaining with a god, if we have one, or the universe. Or maybe we promise to do things di erently from now on and devote our life to making things be er in some way, trying desperately in our mind to make it all OK again. We just want things back the way they were.
Depression The word depression here is used to describe that deep loss, an intense sadness and emptiness, that follows a er a bereavement. This is a normal reaction to loss and does not necessarily indicate a mental illness. Depression is a normal response to a depressing situation. Sometimes people around us can feel frightened by it and naturally want to fix it or cure it, or worse, want you to snap out of it. But recognizing depression as a normal part of healthy grief means that we can try to soothe ourselves through that pain and work hard to re-engage with normal life and look a er our wellbeing as much as we can. The ideas and tools covered in Section 1 still apply here. But we also don’t have to deny pain, or push it down and hide it, as I will explain later. Acceptance When we give grief the time and space it needs, we begin to feel more able to step forward and play an active part in life again. Acceptance can be misunderstood as agreeing with or liking the situation. That is not true. In acceptance, the new reality is still not OK. It is still not as we want it to be. But we begin to take on the new reality, listen to our needs, open up to new experiences and make connections. It is also important to point out that acceptance is not an end point in grief. It might be fleeting moments in which you have found a way to live in this new reality. There may be other moments when you return to bargaining and yearning for that person. Going back and forth between these states is normal, and it’s to be expected as you face all the new challenges and experiences in your life. This means if you have started to find new moments of contentment or joy, things seem to be going OK, and then you find yourself overwhelmed with a wave of anger or sadness (or anything else), that does not mean you have gone backwards. You are not ge ing grief ‘wrong’. Grief comes in waves that we can’t always predict.
Chapter summary Denial can help us survive the overwhelming pain of grief. As denial fades, this allows new waves of emotion to surface. When we experience anger about something we can’t control, using physical movement helps us to use the physiological arousal and bring the body back down to calm for a while. Ruminating over the What ifs can easily lead down a path of self-blame. Depression is a normal reaction a er a bereavement. Acceptance is not the same as liking or agreeing with the situation.
CHAPTER 16 The tasks of mourning So how do we begin to get through this intense, confusing and o en chaotic experience that we call grief? William Worden (2011) described what he thought were the four tasks of mourning. 1. To find some acceptance in the new reality a er the loss. 2. To work through the pain of grief. 3. To adjust to an environment in which that loved one is missing. 4. To find a way to keep a connection with them in a new way while also engaging in life as it is now. A er a loss, people deal with their grief in di erent ways. While some are oriented towards feeling the pain and emotions that arise, others focus on trying their best to distract themselves from the overwhelming emotions. Neither of these are wrong. In fact, we need both. We cannot work through grief all in one go and feel that much emotional pain without rest. But we cannot do the work through grief without allowing ourselves the space to feel it. So the work becomes a process of movement between feeling the pain and replenishing the body and mind with something distracting or comforting that allows you a break between the waves of emotion (Stroebe & Schut, 1999). So spending time with the emotions that come up (whether you made an active choice to go there, by looking in a memory box or visiting a memorial, or if that emotion rose up without choice) is a necessary part of that process. It allows the feelings to unfold and be
expressed, through talking, writing, or weeping. When you feel you need to step back from that, it helps to turn your a ention to something that brings the stress response back down. Using the selfsoothing skills from Section 3 can be helpful (see page 109), especially when the pain has been overwhelming. Grounding techniques may also be helpful here. But there is no set prescription, as every individual, every relationship and therefore every grieving process is unique. The key is to find something safe that allows you some time for restoration, even if that time is short. One of the problems with the ‘trying to get on with it’ mode and not allowing ourselves to focus on the loss at any point is that it can take relentless e ort, and there is no break from that. We might then need to stay busy for fear of being overwhelmed if we press pause. So we become stuck. We’re not able to rest because the work of keeping the pain at arm’s length is constant. When pain is vast, the actions we take to push it down and keep it under the surface can cause damage to both the individual and their relationships. If you disconnect with one emotion, you disconnect from them all. Feel whatever is there It is OK, when you are grieving, to feel everything. It is OK to feel despair. It is OK to feel rage. It is OK to feel confused. It is also OK to feel joy. It is OK to smile if that is where the moment takes you. It is OK to enjoy the warm sun on your face for a moment, or laugh at someone’s joke. It is all OK. It is normal to feel guilty when you start to allow yourself to live again, but allowing small moments of joy to wash over you is just as important to the process of grieving as allowing the pain to. Over time we learn to engage with life and recognize that does not mean forge ing. The love and connection continues. Small steps forward every day
Do not underestimate the power of the smallest steps forward. If standing upright and washing your face every day feels like a ba le, then let washing your face each morning become the current goal. Meet each chapter from where you are and push it where it moves. No expectations Expectations about how you should feel, how you should behave, and how quickly you should heal, only make grief harder. Many of those expectations come from a history of our misunderstanding about grief as a taboo subject. Thanks to some pioneers in this area of research, we now have a much be er understanding of the process of grief and how to help ourselves through it. The expectations lead people to falsely believe that they are going mad, ge ing it all wrong, weak and alone. In reality, all the feelings, the ups and downs, are all a normal part of the process. The lack of conversation about grief leads us to worry about whether we are ge ing it right. The opposite to this, and a much more helpful approach, is cultivating a compassionate connection with yourself and others. One that allows you to express your feelings in a safe place. Expression Expressing how you feel is not always easy. Some have the urge to talk. Others clam up and can’t find the words. If you want to talk, find someone whom you trust and start talking. If you have all of those very normal fears of being a burden, upse ing the other person – say so. A good friend will tell you what they can manage. If you cannot talk, write. In whatever way the words come to you. The act of ge ing those thoughts and feelings out on to the page can help to unravel some of what is going on in your mind and body. It is
through the processing of those painful feelings that the work of grieving is done. Some people find expression through painting, music, movement or poetry. Whatever o ers a safe avenue for you to release and express that raw emotion is worth making time and space for. If you are not sure where to start, just start with anything that comes naturally to you. Start with the thing that has helped in the past. Or start with something just because you are curious about how it might be. If you don’t have a therapist to hold the boundaries for you, this is something you can do to ensure that you step into and back out of the emotion. There is a time to feel and a time to block, a time for turning towards and a time for turning away to rest your mind and body. So if you are going to spend some time releasing and expressing that emotion, have those safety nets that help you back. Remember and keep living When remembering someone causes pain, and engaging in the present without them causes pain, the two experiences can feel at war with each other. The demands of life keep coming and just one memory can crop up and bring you to your knees. Perhaps one of the things that changes over time with grief is the bringing together of these two things. Or the discovery, through trying, of a way the two needs can co-exist. The need to engage in life and the need to remember and stay connected with the person lost. This could be making time for moments that celebrate their life, spending time in rituals that help you to continue your relationship with them, while also making deliberate choices every day to live in a way that honours both past and future. The work of grief appears to be about stepping into your pain, allowing it to wash over you, soothing and supporting yourself through it, and stepping out of it again and into life as it is now, finding ways to
rest and nourish your body and mind through the exhaustion of grief (Samuel, 2017). Grow around the wound The wound that is le following a loss is not something to be fixed or healed. We do not want to forget that person, we want to remember them and continue to feel connected to them. So the wound does not diminish or disappear. It remains while we work hard to build a life around it (Rando, 1993). This is a concept that many people find helpful in therapy. The person is just as important to you as they ever were and so the pain of losing them continues. But we find a way to acknowledge their life while beginning to grow and create a life with meaning and purpose alongside that grief. You find ways to remember, celebrate and feel your connection to that person, and to keep living. You learn that pain and joy, despair and meaning can all be a part of life. You learn what you are capable of surviving, the depths from which you can pull yourself up, and from that, you keep going. When to get professional help Going to a counsellor or therapist does not mean you are ge ing the grief thing wrong. We need support to get us through the pain of grief, but not everybody has someone that they trust or want to talk openly with. The therapy room can become a sanctuary. A safe space to release raw emotion with someone who is trained to sit firm with you through that. The therapist can help you to make sense of things, use skills to help you manage safely, understand more about grief, and listen in a way you have never been listened to before, without judgement, advice or a empts to minimize and fix things for you. A therapist
knows that the work of grief is through the pain, and their work is to walk through it with you and o er a guide when you need it.
Chapter summary Grief demands that we work through the pain. It takes time to adjust to a life in which the loved one is missing. We need to find a way to keep that connection going with the loved one without their physical presence. Acceptance of the new reality means we can continue to engage with the things that ma er to us. Whatever you feel, it’s ok to feel that. Do not underestimate small steps and steady progress.
CHAPTER 17 The pillars of strength The grief psychotherapist Julia Samuel set out the key structures that support us to rebuild our lives through grief (2017). She calls them ‘pillars of strength’ because they take work and persistence to build. By nurturing each of them, we gain a stable structure to help us through. The pillars of strength are listed below. 1. Relationship with the person who has died When we lose a loved one, our relationship and love for that person does not end. Adapting to the loss involves finding new ways to feel close to the loved one. For example, visiting a special place that you shared or spending time at a grave or memorial. 2. Relationship with the self Every other section in this book touches on self-awareness, and working through grief demands the same. In understanding our own coping mechanisms, finding ways to get support and look a er our health and wellbeing throughout, we must listen to our own needs as best we can along the way. 3. Expressing grief There is no correct way to express grief. If you prefer to do that through quiet reflection, memorials or sharing with friends, the act of allowing yourself to feel whatever comes up and expressing that helps the natural process. When emotions are especially
overwhelming, you can make use of the skills o ered in Section 3 to help (see page 99). 4. Time Pu ing an expectation on how much time you should need for grief is se ing yourself up for struggle. When everything is overwhelming, it helps to focus only on each day as it comes until you feel strong enough to take a broader view of the future. Adding pressure to feel a certain way in a particular time-frame only adds pain and distress. 5. Mind and body As I covered in Section 1, our physical state, emotions, thoughts and actions are like weaves in a basket (see page 53). We cannot change one without influencing the other. This makes taking care of all of those aspects of our experience even more important. Regular exercise, eating well and ensuring we maintain some social contact will all help us to strengthen our mental health when we most need it. 6. Limits When loved ones around us may be full of advice about how we should be managing and when we should be ge ing back into everyday life, remembering our capacity for holding boundaries becomes an essential tool. If we are building self-awareness and listening to our own needs, sometimes we need to put boundaries in place and maintain them in order to do what is in our best interests. 7. Structure I have spoken in previous chapters about our human need for balance between predictability and adventure, structure and flexibility. When our mental health becomes vulnerable a er a loss, it makes sense to o er a degree of flexibility that allows for grieving, while also maintaining some level of structure and routine that helps prevent
deterioration of your mental health from the absence of healthy behaviours such as exercise and social contact. 8. Focusing When there are not enough words to describe the sensations that we feel, focusing our a ention on simply observing our internal world and visualizing those sensations in the body can help to build awareness of our own shi s in emotional and physical state.
Chapter summary We can rebuild a life a er a bereavement with time, work and persistence. Create new ways you can feel close to your loved one with a special place or memorial. Listen to your needs as much as you can along the way. There is no correct way to express grief. Drop any expectations about how much time you should spend grieving.
CHAPTER 18 Dealing with criticism and disapproval Criticism and disapproval is something we all have to face at some point. But nobody ever really teaches us how to deal with it in a way that allows that feedback to enhance our life instead of destroying our self-esteem. Even the anticipation of criticism or disapproval can be enough to cause a paralysis in our ability to strive for things that ma er most to us. So not having the skills to deal with criticism or disapproval in a healthy way can cost you. Now, this chapter is not about to tell you to just stop caring what anyone else thinks of you. In fact, we are built to care about how we are being perceived by those around us. Criticism can be a sign that we haven’t lived up to expectation in some way and sometimes (but not always) can signal a risk of rejection or abandonment. So receiving criticism will naturally trigger your stress response. That response gears us up, ready to do something about it. Historically, rejection from our community was a serious threat to our survival. These days, things are di erent in some ways, but similar in others. Rejection and loneliness continue to be a big threat to our health and the brain continues doing its job of trying to keep us safe in a group. Beyond simply keeping us safe, our capacity to imagine what others might think of us is a key skill that helps us to function in the social groups that we live in. We develop our sense of self and identity, not
only from our own experience and how we interact with others, but also through what we imagine those other people really think of us, the ideas and perceptions they might have of us. This is called the ‘looking glass self’ (Cooley, 1902). So it makes sense that what I believe you think of me is going to influence what I do next. So when we try to tell ourselves to just stop caring what anyone else thinks, even if we feel a momentary boost, the impact of that is o en short-lived at best. People-pleasing People-pleasing is more than just being nice to people. Anyone would recommend being nice to people. But people-pleasing is a pa ern of behaviour in which you consistently put all others before yourself even to the detriment of your own health and wellbeing. It can leave us feeling unable to express our needs, likes and dislikes, and unable to hold boundaries or even keep ourselves safe. We say yes, when actually we want and need to say no. We feel resentful of being taken advantage of, but unable to change it by asking for anything di erent. And the fear of disapproval never disappears because there is always the possibility of pu ing a foot wrong, making a wrong choice and displeasing someone – even if that person is someone we don’t like or spend time with. While it is in us all to care about the approval of our peers, peoplepleasing takes it much further. If we grow up in an environment in which it is not safe to disagree or express di erence, if disapproval is expressed with rage or contempt, then as children we learn how to survive that environment. Keeping other people happy becomes a survival skill that we hone and perfect throughout childhood. It is only later, as adults, that those behaviour pa erns become detrimental to our relationships. We second-guess every move we make, always tentatively trying to work out what others are expecting of us. It may even prevent us from making new connections as we hold back on
interactions when there is no guarantee that the other person likes us back. Living a life of people-pleasing is further complicated by the fact that other people don’t always voice their disapproval with criticism. We can fear and feel disapproval even when the other person never says a word. When we don’t have that information, our mind starts to fill in the blanks for us. The spotlight e ect is a term originally coined by Thomas Gilovich and Kenneth Savitsky (2000) to describe the tendency of humans to overestimate how much others are focused on us. We are each at the centre of our own spotlight of a ention and we tend to imagine that others are focused on us too, when in reality, everyone’s spotlights are usually on themselves. So we can o en make the assumption that others are judging us negatively or disapproving when they may not be thinking about us at all. Those who feel socially anxious tend to focus their a ention more on how they are being perceived by those around them (Clark & Wells, 1995). But those who feel more confident tend to have a more outward focus of a ention, leading with a curiosity for other people. So, if we have this brain that is set up to care a great deal what everyone else is thinking, or maybe we notice a tendency towards people-pleasing pa erns, how do we live alongside that? How do we ensure that we can have those meaningful relationships but not become trapped by constant worries about disapproval and judgement? And how can we pick ourselves back up when disapproval from someone else stops us from living in line with what ma ers to us? The tasks of dealing with criticism: Building up the ability to tolerate the criticism that could be helpful and use it to your advantage while maintaining a sense of self-worth. Being open to learning from negative feedback that could help you make progress.
Learning to let go of criticisms that reflect the values of someone else rather than your own. Ge ing clarity on which opinions ma er the most to you and why, so that it becomes easier to know when to reflect and learn and when to let go and move on. Understanding people Most people who are highly critical of others tend to be highly critical of themselves also. It can reflect the way they have learned to speak to themselves and everyone else. They criticize because it is what they do, not necessarily because it is any reflection on your worthiness as a human being, especially when it is a very personal a ack on your character as opposed to anything that could be in any way helpful to you on your path. As humans we also have a tendency towards egocentric thinking, which can play out in our insistence that other people live by the same values and obey the same rules that we have set for ourselves. This means that criticism can o en be based on the critical person’s view of the world, neglecting the fact that we all have di erent life experiences, values and personalities. Understanding that people tend to criticize others based on their own rules for living is helpful to remember, especially for anyone with that tendency towards people-pleasing. We want everyone’s approval, but if each person is unique with their own ideas and views, then we simply cannot please everyone all of the time. If we have a close relationship with the person, then we are likely to value their opinions more (which can make the criticism more painful), but we also may have the insight to be er understand what lies behind the disapproval. Context is everything, but we don’t always have access to it. When we don’t have that context, it is much harder to see the criticism for what it is – one person’s idea that is wrapped up in their own experiences. The natural instinct is to take on the criticism as a factual
statement that says something about who we are and to start questioning our own self-worth. Nurturing self-worth Not all criticism is bad. When feedback focuses on a specific behaviour, we tend to feel guilty, which prompts us to correct our mistakes to repair the relationship. When criticism a acks our personality and our sense of worth as a person, we tend to feel that in the form of shame. Shame is the intensely painful feeling that can be mixed with other emotions like anger or disgust. It is di erent from embarrassment, which is less intense and tends to be felt in public. Shame is much more painful. We feel unable to speak, think clearly or do anything. We want to disappear and hide. The sheer intensity of the physical reaction makes it di cult to recover from. Shame triggers our threat system in such a way that it can feel like someone held a match to all our other emotions. So we get a rush of anger, fear or disgust to go along with it. Then the self-a ack comes swarming in like soldiers over a hill, coming at you with self-criticism, self-denigration and blame. With that sort of onslaught the instinct is to block it all out. But shame is not easy to ignore. So we go for the most absorbing, addictive behaviours that o er instant relief. Shame resilience is something we can learn, but it is a life practice. Building resilience to shame does not mean you never feel it. Instead, it means we learn how to dust ourselves o and get back up. Being able to experience shame and come back from it without losing your sense of self-worth involves: Ge ing to know what triggers shame for you. There are certain aspects of our lives and things we do that we perceive to be a part of who we are. That may be parenting or physical appearance or creativity. Anything that you link to your self-worth can give rise to shame. In order to build and maintain a sense of self-worth, we
need to understand that our worthiness as a human being is not dependent on living mistake-free. Reality-checking the criticism and all the judgements that follow. Whether it comes from someone else or inside your own head, judgements and opinions are not facts. They are narratives and stories that can significantly change our experience of the world. So looking a er your self-worth involves taking the name-calling and personal a acks out of the equation and focusing on the specific concrete behaviours and their consequences. Reminding yourself that being imperfect, making mistakes or failing is all a part of being human. Making friends with your fallibility means that when you do fail you don’t have to feel worthless. You can use each experience to your advantage by learning from it. Minding what you say. Criticism will always hurt a li le; that is our brain doing its best to keep us safe. There is no antidote that makes it all OK forever and ever, criticisms bouncing o your armour. What use is armour anyway, when the worst critic is in your own head? A harsh comment or criticism can leave you feeling winded. Of course, naturally, you then spend the next five hours rehearsing it again in your head. The brain wants to pay a ention to it because it is a threat. But each time you go over it in your mind, the stress response is triggered again. So one kick in the stomach can feel more like a hundred kicks in the stomach. Time spent thinking over a helpful criticism that we can put to good use and that adds to the work we are doing in the world is time well spent. Ruminating and churning over a nasty comment with no sense of how this can help you is just a continuation of the a ack on your character. Talking to yourself in the right way a er a criticism. This is vital if you want to have the capacity to move through shame and bounce back. When we are in shame we may feel a sense of self-loathing, and we convince ourselves that we need to continue the a ack. The idea of responding to ourselves with respect and compassion
feels undeserved and indulgent, as if it would let you o the hook and stop you bothering to try harder. But in reality, if you want a man to get up o the ground, you have to stop beating him. The key to using all criticism to your advantage is having your own back, having so much self-compassion that you are able to listen to criticism and decide which of that criticism you will take on board and use to your advantage as a learning experience, and which voices o er you nothing but dents in your self-esteem and crushed confidence. Talking about shame itself. Reach out to someone you trust and confide in them. Secrets, silence and judgement intensify shame. Sharing our experience with someone who responds with empathy helps us to leave shame behind and move on. Understanding you Living the life you want to live in the face of criticism means ge ing clear on: The opinions that truly ma er to you and why. Whose opinions ma er most to you? Saying ‘I don’t care what anyone thinks’ is rarely true and hides a world of insecurities. It stops us creating meaningful connections with others because it closes o any avenue of communication in which both voices ma er. But the list of whose opinions truly ma er needs to be small. It is also worth pointing out that acknowledging who ma ers does not mean it is your responsibility to please them. It just means you are willing to listen to their feedback, even when it is not praise, because you know it is likely to be honest and in your best interests, therefore most likely to be helpful. Why you do what you do. The one person you most need the approval of is you. When the way we are living is out of line with our values and what ma ers most, life stops feeling meaningful or
satisfying. Understanding the kind of person you want to be and how you want to live your life, how you want to contribute to the world, is the road you want to stay close to. When you know exactly who you are and who you want to be, it is much easier to choose which criticisms to take on board and which ones to let go. Where those familiar critical voices are really coming from and whether they are warranted and helpful or detrimental to our wellbeing. When there is someone in your life who is predictably critical, you hear their voice before they even say anything. Over time we internalize their constant criticism so that it becomes the way we speak to ourselves. So we may be highly self-critical because we have learned to be. Recognizing that we learned that way of speaking to ourselves helps us to acknowledge that we can re-learn a new internal dialogue that serves us be er.
Chapter summary Learning the skills to deal with criticism and disapproval in a healthy way is a crucial life skill. We are built to care what others think of us, so telling ourselves that we don’t care is not the answer. People-pleasing is more than just being nice to people. It is the persistent placing of others’ wants or needs above your own, even to the detriment of your own health and wellbeing. Understanding why some people are highly critical helps. Nurturing your own self-worth and resilience to shame is both possible and potentially life-altering.
CHAPTER 19 The key to building confidence As a teenager growing up in a small town, I thought of myself as a confident person. Then I le that small town and went o to university over 100 miles away. But much of my confidence, which I thought was part of me, stayed at home. I was vulnerable, unsure of myself, not clear on who I needed to be to fit in. Over time, university life became the new normal and I built up my confidence, brick by brick, once again. A er I graduated I got a job as a researcher for an addictions service. Feeling confident to meet the demands of university was no longer enough. I needed to tolerate that vulnerable feeling once again in order to build up confidence in this new arena. The same happened when I began my clinical training, then a er qualification, a er the birth of my first child, when I started my own practice and again when I started making my work public on social media. With every turn I have ever made, the confidence that once seemed enough suddenly seems inadequate and vulnerability returns. Confidence is like a home that you build for yourself. When you go somewhere new, you must build a new one. But when we do, we’re not starting from scratch. Every time we step into the unknown and try something new, experience that vulnerability, make mistakes, get through them and build some confidence, we move on to the next chapter with evidence that we can get through tough challenges. We bring with us the courage we need to take that leap of faith again and again. That same leap of faith the trapeze artist must take every time she lets go of one bar before grabbing the next one. She is always
vulnerable, never completely safe, but each time she tries, she knows she can meet that risk with the courage needed to make it happen. To build confidence, go where you have none Confident is not the same as comfortable. One of the biggest misconceptions about becoming self-confident is that it means living fearlessly. The key to building confidence is quite the opposite. It means we are willing to let fear be present as we do the things that ma er to us. When we establish some self-confidence in something, it feels good. We want to stay there and hold on to it. But if we only go where we feel confident, then confidence never expands beyond that. If we only do the things we know we can do well, fear of the new and unknown tends to grow. Building confidence inevitably demands that we make friends with vulnerability because it is the only way to be without confidence for a while. But the only way confidence can grow is when we are willing to be without it. When we can step into fear and sit with the unknown, it is the courage of doing so that builds confidence from the ground up. Courage comes first, confidence comes second. This doesn’t mean that we have to dive in at the emotional deep end and risk overwhelming ourselves. But it does mean that we must recognize how fear helps us to perform at our best and that we need to change our relationship with that fear so that we no longer need to eliminate it before we try. We learn to take fear with us. Here is the Learning Model (Luckner & Nadler, 1991) that we can use as a guide for building confidence. Note down what aspects of your life might be in the comfort zone, what tasks feel challenging but manageable and which things you would put in the panic zone. Every time you step into the stretch zone, you are doing the work of building your confidence by flexing your courage.
When you are trying to build self-confidence, it is a process of building self-acceptance, self-compassion and learning the value in vulnerability and fear. It is o en a balancing act that doesn’t always feel easy. Along the way, all of the tools in this book can be used, as they each help to build up your capacity to both lean into e ort and tolerate the discomfort, then pull back and replenish. Figure 8: The Learning Model (Luckner & Nadler, 1991). Some of the main ingredients for that leap of faith we need for stepping into the stretch zone are: Recognition that you can improve with e ort. Willingness to tolerate the discomfort of being vulnerable for a while.
The commitment to yourself that you will always have your own back and do the best by yourself whether you succeed or fail. This means embracing self-compassion as a life practice and being your own coach, not your worst critic. Understanding how to move through the shame that can arise from failure to prevent our tendency to quit on our dreams in an e ort to avoid the shame of a setback. See Section 3 for more on this. To build confidence, we don’t have to live in fear. We have to develop a daily pa ern of stepping into fear, si ing with it, and stepping back out, giving ourselves time to recover and replenish ready for tomorrow. See Section 6 on fear. Why you don’t need to work on your self-esteem There is a whole industry built on the concept of self-esteem and the idea that if we can just believe in ourselves, we will perform be er and improve our relationships and our overall happiness in life. Self-esteem generally means being able to evaluate yourself positively and believe in those appraisals (Harris, 2010). So anyone trying to help you increase your self-esteem might ask you to list what you like about yourself and what your strengths are, and try to convince you to believe that you can become a ‘success’ in the world. But we have a problem with the concept of ‘success’. We link it to the idea of wealth, winning, standing out and being acknowledged by others. So how do you know if you’re winning? You compare yourself to others. Maybe you go online and pick any of the 4.6 billion internet users from across the world. With a pool that size, you are guaranteed to find someone who is doing be er than you at something. When you do, self-esteem might take a hit because if you are not the winner, you can start to see yourself as a loser instead. What if you stay o ine and only compare yourself to your friends and family instead? Doing that is not going to nurture healthy
relationships. Associating a measure of ‘success’ to worthiness would inevitably make it di cult to truly connect with the people you are comparing yourself to. What happens when you lose your job and your friend gets a promotion? A review of the research by a group of psychologists showed that high self-esteem is not linked with be er relationships or be er performance. But it does correlate with arrogance, prejudice and discrimination (Baumeister et al., 2003). They found no significant evidence that trying to boost self-esteem through intervention had any benefits. Self-esteem cannot be relied on when it is contingent on being a ‘success’. It is psychological rent that you can never stop paying. The second you notice signs that you might be less than, you brand yourself as not enough. So you keep running on a hamster wheel of success, driven by a scarcity mindset and the fear of being inadequate. Ditch the positive affirmations You cannot open a social media platform without coming across an o ering of daily a rmations. The idea behind this is that if you say something to yourself enough times you will start to believe it and become it. But as it turns out, things aren’t quite that simple. For those who already have high self-esteem and believe in themselves, repeating a rmations can have a small benefit of feeling a li le be er. But some studies have shown that for people with low self-esteem, repeating a rmations and statements that they don’t believe, for example, ‘I am strong, I am lovable,’ or being asked to focus on all the reasons that statement is true, tended to make them feel worse (Wood et al., 2009). The reason for this may be that internal dialogue we all have. If you say out loud that you are strong and lovable, but you don’t believe that you are, then your inner critic will get to work coming up with all the reasons why you are not strong or lovable. The result is an internal ba le, and plenty of time to focus on all the narratives that bring you down while you are desperately trying to push them away.